As a Medicare Advantage plan that also provides medical care to its members, CareMore partners with primary care physicians to identify and refer high-risk patients who would benefit from support at its Care Centers, where multidisciplinary care teams manage patients’ needs holistically and oversee acute care.
By spending more to anticipate and address the medical challenges its frail and chronically ill members will face, CareMore aims to prevent and slow the progression of disease rather than treat its complications. In 2015, CareMore members had 20% fewer hospital admissions, 23% fewer bed days, and a 4% shorter length-of-stay than beneficiaries covered under fee-for-service Medicare. A comparative analysis of Medicare Advantage plan pricing for beneficiaries in average health indicates CareMore is more efficient in providing standard Medicare benefits than market competitors on average. Read more
The high-desert region encompassing Pueblo in southeastern Colorado was one of only 14 out of 306 regions nationally to improve on a majority of performance measures tracked by the Commonwealth Fund’s Scorecard on Local Health System Performance.
Socioeconomic challenges and geographic isolation have fostered a sense of interdependence among local health care providers, who have leveraged the state’s Medicaid expansion to enhance access to care while improving coordination. Providers have also joined with public health and social service agencies, businesses, educators, and nonprofits in creating the Pueblo Triple Aim Corporation, an improvement collaborative that uses data to define problems and create shared accountability for solving them. The group engaged the community in youth development programs as part of an effort that reduced the teen pregnancy rate by more than half. This and other collaborative efforts tap state policy to accomplish local priorities while seeking to build community pride. Read more
Health Share is a nonprofit founded in 2012 to coordinate the provision of medical, dental, and behavioral health care for Medicaid beneficiaries in a tricounty region encompassing Portland, Oregon.
As one of 16 coordinated care organizations designated by the state to oversee and improve the delivery of these services for a geographically defined population, Health Share receives a global budget. It distributes per-capita payments to health plans—some of which are integrated delivery systems—and county-run mental health agencies that have agreed to accept risk for providing or ensuring access to defined services. These risk-bearing entities—all founders of Health Share—serve on its governing board, along with representatives of community-based organizations and social service agencies committed to this population. Health Share brings these stakeholders together to improve care for high-need, high-cost patients; achieve efficiencies by centralizing certain administrative and enrollment functions; and create accountability for performance. Read more
NOTE: These case studies were conducted under a contract with the Commonwealth Fund. The views expressed are the authors and do not necessarily reflect the views of the Commonwealth Fund or its officers, directors, or staff.